| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN STREET, STE 300 MENASHA, WI 54952 | SUN LIFE ASSURANCE COMPANY OF CANADA | $0 | $7K | $7K | 1.35% |
| UMR, INC.3 | 5151 PFEIFFER ROAD, ML 400 PFEIFFER WOODS CINCINNATI, OH 45242 | SUN LIFE ASSURANCE COMPANY OF CANADA | $3K | $0 | $3K | 0.65% |
| R & R INSURANCE SERVICES INC3 Filed as: R & R INSURANCE SERVICES INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | SUN LIFE ASSURANCE COMPANY OF CANADA | $18K | $0 | $18K | 9.27% |
| MCCLONE AGENCY INC3 Filed as: MCCLONE AGENCY INC. | 150 MAIN STREET, STE 300 MENASHA, WI 54952 | SUN LIFE ASSURANCE COMPANY OF CANADA | $5K | $0 | $5K | 2.31% |
| R & R INSURANCE SERVICES INC3 Filed as: R & R INSURANCE SERVICES INC. | N14 W23900 STONE RIDGE DRIVE WAUKESHA, WI 53188 | WYSSTA INSURANCE COMPANY INC. | $2K | $0 | $2K | 7.93% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 270 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 274 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | SUN LIFE ASSURANCE COMPANY OF CANADA | 214 | $486K |
| Vision | WYSSTA INSURANCE COMPANY INC. | 149 | $24K |
| Life insurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 270 | $197K |
| Short-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 270 | $197K |
| Long-term disability | SUN LIFE ASSURANCE COMPANY OF CANADA | 270 | $197K |
| Stop-loss / reinsurancereinsurance | SUN LIFE ASSURANCE COMPANY OF CANADA | 214 | $486K |
| Other(3 contracts, 3 carriers) | SUN LIFE ASSURANCE COMPANY OF CANADA | 366 | $225K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 366 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.